摘要
目的 探讨创伤性中下段腰椎(L2-L5)骨折后神经功能损伤的影像学风险因素.方法 回顾性分析该院2019 年1 月～2022 年 10 月收治的71 例创伤性中下段腰椎(L2-L5)骨折患者资料,根据ASIA分级进行神经功能评估,将患者分为损伤组31 例和未损伤组40 例.统计两组患者的人口学资料和临床资料,并在矢状位和轴位腰椎CT片上测量以下影像学指标:椎管侵占率、椎体前缘高度比、椎弓根内侧间距比值、伤椎Cobb角和是否存在椎板垂直骨折等.对两组患者的上述资料进行比较,将P＜0.05 的相关因素纳入到多因素Logistic回归模型进行处理;采用ROC曲线确定独立影响指标的最佳截断值,采用曲线下面积(area under the curve,AUC)对其预测价值进行评价.结果 71 例中,31 例(43.7%)出现神经功能障碍,ASIA分级为A级3 例(4.2%),B级5 例(7.0%),C级3 例(4.2%),D级 20 例(28.2%);其中,有 24 例(33.8%)存在下肢无力,16例(22.5%)存在自主神经功能障碍.损伤组和未损伤组患者的损伤水平、骨折AO分型、椎管侵占率、椎体前缘高度比、椎弓根内侧间距比值、椎板垂直骨折的占比等数据,差异有统计学意义(P＜0.05).经 Logistic 回归模型分析,损伤水平(P = 0.021)、椎管侵占率(P=0.007)、椎体前缘高度比(P=0.036),均是与患者神经功能损伤相关的独立影响因素.ROC曲线分析得出,仅椎管侵占率具备良好的鉴别能力(AUC =0.874,95%CI=0.791～0.957),其最佳截断值为47%,灵敏度为 90.3%,特异度为 80%.结论 损伤水平、椎管侵占率和椎体前缘高度比,均是创伤性中下段腰椎(L2-L5)骨折后神经功能损伤的影像学风险因素,其中椎管侵占率与患者神经功能损伤的相关性最强,最佳截断值为47%.
Abstract
Objective To investigate the imaging risk factors for neurological impairment after traumatic lower and middle lumbar spine(L2-L5)fractures.Methods The clinical data of 71 patients with traumatic lower and middle segment(L2-L5)lumbar frac-tures admitted to our hospital from January 2019 to October 2022 were retrospectively analyzed,the neurological function assessment was performed according to the ASIA classification,and the patients were divided into 31 cases in the injured group and 40 cases in the uninjured group.The demographic and clinical data of the two groups were counted,and the following imaging indices were measured on sagittal and axial lumbar CT films:canal encroachment rate,height ratio of the anterior vertebral body margin,ratio of medial pedi-cle spacing,Cobb angle of the injured vertebra,and presence of vertical fracture of the vertebral plate.The above information was com-pared between the two groups of patients,and the relevant factors with P＜0.05 were included in the multi-factor logistic regression model for processing;the ROC curve was used to determine the optimal cut-off value of independent impact indicators,and the area un-der the curve(AUC)was used to evaluate their predictive value.Results Of 71 cases,31(43.7%)had neurological dysfunction,with an ASIA classification of grade A in 3 cases(4.2%),grade B in 5 cases(7.0%),grade C in 3 cases(4.2%),and grade D in 20 cases(28.2%);among them,24 cases(33.8%)had lower limb weakness and 16 cases(22.5%)had autonomic dysfunc-tion.Data on injury level,fracture AO typing,canal encroachment,ratio of anterior vertebral body height,ratio of medial pedicle spacing,and percentage of vertical fractures of the vertebral plate were statistically significant in patients of the injury and non-injury groups(P＜0.05).After logistic regression analysis,the level of injury(P=0.021),spinal canal encroachment(P=0.007),and anterior to posterior vertebral height ratio(P=0.036)were all independent influencing factors associated with neurological impairment of the patients.ROC curve analysis yielded that spinal canal encroachment alone had good discriminatory power(AUC =0.874,95%CI=0.791-0.957),with an optimal cutoff value of 47%,sen-sitivity of 90.3%,and specificity of 80%.Conclusion The level of injury,spinal canal encroachment ratio and anteriorto posterior vertebral height ratio,are all radiographic risk factors for neurological impairment after traumatic middle to lower lumbar(L2-L5)fracture,among which spinal canal encroachment has the strongest correlation with neurological impairment in patients,and its optimal cut-off value is 47%.
万方数据